Adult ADHD assessment and diagnosis pathway

You may start by noticing repeated difficulties with attention, organisation, starting or finishing tasks, restlessness, impulsive actions or the effect these have on everyday life.

Before asking for an assessment, note two or three real examples. Include what happened, how often it happens and the effect on work, education, relationships, money, home or daily living.

The Adult ADHD Self-Report Scale version 1.1 (ASRS-v1.1) asks adults about experiences associated with ADHD. Its short screener has six questions and helps identify whether a fuller assessment may be useful.

Open the official ASRS information and six-question screener. Choose ASRS v1.1 Screener-English on that page.

You can complete this self-report questionnaire yourself. A GP, mental health professional or another service may give it to you, review it with you or ask you to complete it again as part of its own process.

• A higher score: take the result and your real-life examples to the professional who handles referrals in your local pathway. The score supports a conversation; it does not diagnose ADHD.
• A lower score: ADHD may be less likely on this screen. If the difficulties still have a significant effect, take your examples to a professional and ask them to consider ADHD and other possible explanations.

Sleep problems, anxiety, depression, trauma, substance use, physical illness and other neurodevelopmental or mental-health conditions may affect the answers. NICE says ADHD must not be diagnosed from a rating scale alone.

For many people, the first appointment is with their GP. Depending on the local pathway, an appropriate mental health professional or another named service may also discuss the problem and arrange or support a referral.

Take your screening result if you have one, along with two or three current examples and anything you know about similar difficulties during childhood. The professional will consider the effect on your life, whether a specialist assessment is appropriate and whether anything else needs attention.

The referrer sends the information required by the chosen service. The service then checks the referral, which is often called triage.

It may accept the referral, ask for more information, redirect it or explain why its criteria are not met. Forms, evidence requirements and contact arrangements differ, so follow the instructions from the actual service receiving the referral.

You do not need to produce your entire life history at once. Useful information may include:

• current examples from more than one part of life;
• what happens, how often and what consequence follows;
• similar difficulties during childhood or education;
• relevant mental and physical health history, medication, sleep and substance use;
• school reports or other records, if available;
• information from somebody who knows you well and can describe what they have noticed;
• where possible, information from somebody who knew you during childhood.

NICE includes observer reports as part of the diagnostic process, so the assessment is not based only on a questionnaire or your account. If there is nobody suitable to provide information, tell the service rather than abandoning the assessment.

Use the service’s appointment instructions. Some assessments are in person, some are remote and some are split across more than one appointment.

A full assessment is a structured clinical process, not one test. NICE says ADHD should only be diagnosed by a specialist psychiatrist or another appropriately qualified healthcare professional with training and expertise in diagnosing ADHD.

The assessment should include:

• a full clinical and psychosocial assessment;
• your developmental and psychiatric history;
• symptoms and behaviour across different settings;
• the effect on important areas of everyday life;
• mental state, physical health, needs and coexisting conditions;
• observer information where appropriate.

The assessor looks for a persistent pattern that began during childhood. They also consider other explanations and conditions that may exist alongside ADHD, including anxiety, depression, bipolar disorder, autism, trauma, sleep disorders, learning difficulties, substance use, medication effects, chronic pain, physical illness or brain injury.

The assessor should explain the outcome and the reasons for it. Ask for a copy of the assessment report and check who is responsible for the next stage.

If ADHD is diagnosed, the report may describe one of three main current presentations:

• Predominantly inattentive presentation: the main current pattern involves inattention.
• Predominantly hyperactive-impulsive presentation: the main current pattern involves hyperactivity and impulsivity.
• Combined presentation: both patterns are present.

“Presentation” is the current term rather than “type”. It describes the symptom pattern; it does not describe your intelligence, personality or worth.

• If ADHD is not diagnosed: you may still recognise ADHD-like traits, but the assessor may decide they do not cause enough impairment, do not occur across enough settings or are better explained by something else. Ask what the assessment did identify, whether another explanation needs assessment and what support is available for the difficulties that remain. If you rely on routines, reminders or support to manage, explain both what helps and the effort involved at your assessment.
• If more information is needed: ask exactly what is missing, who needs to provide it and how it should be returned.

For many adults diagnosed with ADHD, medication is one of the main treatment options discussed next. It is a choice, and the specialist should explain the expected benefits, possible harms and other options.

Before medication is started, NICE recommends a baseline assessment. This usually includes:

• confirming that ADHD criteria are still met and treatment is needed;
• reviewing mental health, social circumstances and other conditions;
• reviewing current medication and any substance-use or medication-diversion risk;
• measuring height, weight, pulse and blood pressure;
• reviewing medical and cardiovascular history and carrying out a cardiovascular assessment.

An ECG is not routinely required. It may be needed when there are particular cardiac symptoms, history, examination findings or another medicine that could increase cardiac risk.

If a possible heart problem is identified, the specialist may seek a cardiology opinion before prescribing. This does not automatically mean medication cannot be used; it means the risks need assessing and the treatment plan may need changing.

If medication is started, the dose is adjusted and monitored for benefit and unwanted effects. Once treatment is stable, clarify who will prescribe, who will complete reviews and whether an agreed shared-care arrangement is in place.

Psychoeducation means learning what ADHD is, how it affects you personally and what may make everyday life easier. It may be offered individually, in a group or through written, audio or video material.

Open the Psychoeducation section for guided learning and facilitated support by area →